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tv   [untitled]    March 20, 2014 12:30pm-1:01pm PDT

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help people stay in their homes if at all possible. we also know and again, you as well our department and people across the community know that there's been this net to link health and social support sponsor those two things have to come together we're successful sometimes but not in the arena of long-term care. in the past 20 years there i was thinking under the 3 different mayors to link those together better and now we have this opportunity under the the affordable care act the department and adult staff and the long term council you'll see later in the document on the
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oversight committee just how we framed all the work but again, the health department and others were involved in all the work. i'll have ilene talk about the work and i'll talk about some of the recommendations. you don't have a clock in the front so here's my watch to stay within the time >> thank you for the opportunity for the information for the plan. i'm with the citizens health care and chair the group with another colleague. as ann mentioned it started with the initiative from the long-term care cooperate council but under the leadership of looking ahead with the ac a and the work in the state and how to
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better prop prepare for that with funding and support the coordinating group was created it's the long term services and support as ann mentioned we're talking about older and young adults with disabilities and when we talk about long term care integration we're talking about institutional and community based services. in terms of the state initiative going on i'm going to spend time with the kworntdz care initiative it was introduced by governor jerry brown for california's effort to better coordinate care for californians. it's created with a lot of opportunity created by the
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affordable health care and how can better care b be coordinated and the cost savings. there's no - it effects quality and effects the cost of care so with the coordinated care initiative one part is called cal medical connect the dual particle is one of 15 states selected by the federal government for some funding to create a pilot program to better coordinate care for dual eligible since medi-cal and medicaid nationally are two program that are aligned the rules don't fit well, with both programs those people that are
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dual eligible are people with seers health conditions and have problems getting the care they need instead of what is reimbursed some of the mississippi alignment drivers the quality of care and increased costs. the cal medical connect program is focused on dual giggles medi-cal and medicaid beneficiaries and to combine all health services plus the two into a package it's through managed care. based on the traditionally medi-cal managed care plan and in addition the pace program is offered as an option because of the history of sgrath care through the pace model and through the model the plans the
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capital payment for the medi-cal and medicaid services. the long term services and support that are included include in home services and the services program and skilled nursing care. the adult services program is the new name for the health program and is already part of the managed care right now. as i mentioned cal medical connect is one piece of the program and the other is for medi-cal beneficiaries who are maybe not medicare eligible or choose not to enroll they'll be required to enroll for the long term services and support so the second is called the long term support program.
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in terms of the coordinated cal program 8 county have been authorized to moved in this initiative. you see the list of county here in the bay area is alameda and san mateo and santa clara and los angeles and san bernardino and san diego and riverside. as part of the evaluation of readiness the centers for medi-cal and m.d. services have done readiness assessments to determine whether the plans in the county are ready to move forward the earliest is april of 2014. at this point there's one county moving forward for april 2014 a that's san mateo but the other county are basically going to move forward bans they're readyness in he remembers of the health plans and the services
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for readiness. so for example, alameda county is scheduled to start in july of 2014 and sarah county is scheduled to start in january of 2015 there's a variety of start dates so in terms of menacing the enrollment process for the most part they'll be enrolled by their birthdays so people will get before it their birthday they'll get a 90 day novs notice and a 50 and thirty day notice. they need to a choose a plan option or they'll be possibly enrolled similarly with people with disabilities what their
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enrolled their defaulted if they don't make a choice so communication is important in this effort. so it's the states intent to expand beyond the county and their goal is to expand the program statewide are there's certainly a desire and belief that better integrated care will be better quality for beneficiaries. so additional legislation will be enacted and with that, the inclusive of san francisco county will be in 2006. there's interested in expanding to other counties as well. the managed care options available in san francisco include san francisco health plan is the public option and anthem blue cross those are the
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two plans that care in san francisco for a number of years primarily focused on families and citizens are medi-cal only and in areas where the programs are available the plans are available likewise. so to give you an idea of the target populations there are estimates of the population that are dual eligible from 22 to 64 so there's in trouble in looking at the roll out of more people who enroll in managed care effect the significant number of population here. i'm going to turn it over to ann to a talk about the
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recommendation. >> the long term coordinating council have taken on other initiative and we've used a similar planning guide to do that first of all, it's convening an oversight committee or a design group and really determining who are the best folks to sit on that and then look critically at the information that comes from the various work groups so you'll see here not only do we have 3 different departments on it we have through the health plan we had some of the key community provides work in the union and consumer advocates and the mayor's office is involved as well. we broke this into at some .6 work groups 4 major ones we did data and finance services and a
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cooperation of services and an analysis of various information and so on this is a in the report itself. i wanted to move from who is looking at this to the what the recommendations were that came out of the group. the first one was for initiative run access for long term services ease supports it was interesting for our department it stated that we should take a leadership role and create a door. he know with a no wrong door approach is very helpful many folks have relationships with community providers and they need to keep those relationships but we need a place for community providers to come together and seek out other
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information as well so having that balance of making sure that all the doors in the community are strong as they can be. and we've begun working on something like that we're expanding this work because of the work in this area. we're doing the transition from hospital to home and there are i think takes we do home delivery meals and it's a natural fit but it was great to see come out of the community partners as a recommendation. you can really look at some of the other recommendations and their pretty well clear. i wanted to highlight a little bit related to training for caregivers and also the recommendation related to helms and dementia research that's
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another initiative that the county is undertaken. we've got a long-term strategic plan that relates to dementia in our county and other places have begun to use this for an example this data has found its way into the data this is a population that is growing rapidly. for us we see consistency with the recommendations here as we've seen in other plans as well. backing up a minute you'll see a list of some of the items. that determined to be crucial elements of any long term car system the behavioral health and nutrition he know people need.
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the last i guess there's a couple of recommendations that we have been moving on. quickly because the opportunity presented itself and one of them was that there was a recommendation related to trying to make sure that nonprofit providers having had as much opportunity as possible to work in the business world of managed care. so in this last year the administration for community living in washington, d.c. had a quest of proposals out they were will i willing to fund 9 community in the country and the idea was exactly what we put so what the plan if providers who are unaccustomed to working with
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the medical community or selling goods and services to people who are going to want to buy those items for their consumers and clients then people needed to be ready to do that. so it opportunity arose this last winter we accessed it and was selected as one of the 9 community and at this point are in conversation with the provider. another community several community providers in the southern california region are looking at doing some similar and helping he easter each other to be successful in this area. the last recommendation you'll see in your packet you can ignore the resolution at the end of the packet this is the reason we're here that is there was
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recognition there needed to be an implementation body just as we needed an implementation body for the dementia program. it was recommended by this body that that implementation body would include the 3 departments dos and human service go agency and the health plan and in addition to the coordinating council. we're hoping to convene this group in may and dos will be providing the staff to the group and we'll be in its first meeting determining who should be this oversight body it's was broadly put together. again, we will not be implementing this cc i will not be coming to san francisco but in 2016.
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what we've learned from other counties remember this work started two years ago it's taken the county to get to a place to implement something and only one of them is ready in april and hoping for too more in june. we believe as far along as we are in our collaborations with your county partners there's a lot of work to do to present. we believe that that work let's say managed care and the cc i never came it will help to us better serve the people in san francisco. we see a lot in the plan we can moved on whether cc i comes or not. with that, we will entertain questions. >> was there any public comment first and there's no public
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comment. >> okay commissioner melara. >> yes. a couple of places ilene i'm familiar with the case by it would be good for the commission that don't know about this it's a great bottle to say in san francisco. >> the pace stands for the all inclusive care for the elderly it started in san francisco it was started over thirty years ago and it really is designed to focus on individuals who are certified to be eligible to be in a nursing home but want to stay in the community as long as possible it begin with medical services and primary care services as well as long-term services and community services. i think that where it is kind of
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a blend a managed care program but also a provider because those programs operate their own centers and clinics where people come during the day it get a spectrum of services including home care. it is a complete package of medi-cal and medicaid services in addition to the services that the interdisciplinarian team and physical and occupational theorists put together. >> those buses you see on the street initially pickup those seniors from their home i even operate housing facilities. >> housing is not covered by the pace program but knowing how important housing is ease certainly san francisco has been
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a leader is housing is so important to having people stay in higher home and community and getting care there soaps to going into institutions. definitely some of the non-traditionally home delivered meals are part of the package >> and the second and final question is this is more for ann as the leader of this. is what is comes to in my mind all the time is that those services are targeted for those people who are medi-cal eligible but we have another group of servers r search and seizure in your community that are falling through the cracks who were probability a hundred dollars away from not obeying being eligible for medi-cal we're a aging population for a
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comprehensive city and yet we have no services or least e at least the eligibility criteria if we can in our future vision look at healthy san francisco where san francisco, california become the place to create a program that can look at expanding the eligibility criteria and cover people also in need but unfortunately basis of, you know, $30 or $20 kw4s nothing in usual city are truly falling through the cracks and not being served. some of the legislation both our advisory committee and commission looked is the asset limit and income limit on medi-cal. their share of costs program a great if you can afford the
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share of costs but a lot of people can't afford to pay that. so i think we have been looking and every time we run into people one of the things i'm hoping that happens with the business collaborative we'll inevitable grow the dollars that exist within our community in addition to what we do as departments and mayor on board put together but find other ways to grow that pot that can help and use the innovative and creativity thing in the san francisco village we're looking at the cafe in chicago they've been doing looking at where those opportunities to do something that's not the same as what we've been doing by bring the education and other kinds of
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things that can be helpful to people and help connect to the things they can't afford. a that's an excellent comment >> commissioner sanchez. >> this has been an excellent report we had on the population our public health committee a while back when presented in depth and also vice president ma letter was there and the presentation was quite in debt and brought out critical issues but the fact that this process has taken over two years you've been inclusive in the dialogues in which you've that been generating in a comprehensive program and i mean institutions
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such as the honda and our community input our community programs like central latino and all have been parts of the dialog and found out how we're going to face the challenges in the future so your key he recommendation is to have this task force to really provide oversight plus the leadership through the aging is critical as we move forward and the projected date is 2016. there's only one question i had in reference you've presented 44 thousand was that the projection of 2014 or 6 and that will grow by 10 thousand and more was that your understanding >> it was scheduled to go. >> could you please speak into the microphone we're mindful
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because this is being picked up by our sfgov and requires we speak into the microphone. >> so i can get you the exact date but i expect that number to grow. >> great a great report and long overdue and taken a lot of leadership and collaboration that's the spirit of how things get done in the city. >> commissioner sako. >> i agree it's thorough the questions i have, you know, being someone from the lgbt community it comes up about social competency and also when you mentioned the service providers setting on the working group was there any open house
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group part of that or the lgbt seniors were they part of the planning body? >> trying to remember in the task force had been formed i don't think it had been so some of our staff was certainly involved in that and keeping in mind this at the same time, we through the net were trying to make sure we were 2011 everyone to the table also, because the communication of what's going on is so important so we did do a series of town hall meeting we're going to do more in the future to a gather back from people what's working and not working so again those are possible venues and there will be more in the future we'll be looking to do as well.
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thank you. >> i'd like to clarify you're looking for us to actually not simply support the report that comes from the design group but it's not the xylophone group that carries on the work your suggesting we point towards the l tci implementation body as being a parent on that body. >> yes. that's correct. >> so it won't be the design group i was going to ask the director that the direction we're looking at we might be able to modify this commissioners, if someone would make a motion instead of continuing to work with the design group it would be to work within - to form - >> i participateed in the implementation. >> to participate or we're
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spotted to help formulas. >> right the language in the resolution i think where the language is off we know that times are changing fast we don't want to come forward with a resolution to implement this because things could move faster we're wanting to form that implementation body and we believe it's critical for the partners that have been mentioned in recommendation 13 didn't have a package number that we go forward with that. >> okay. so actually you're asking us to continue to develop a implementation plan including the formation of l tci implementation body? because now we're not working with the design group.
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>> ; is that right. >> that meets with the departments. >> absolutely we'll be more than happy to participate. >> yes. yes, that's why i'm trying to change the resolution so it doesn't point to the design group we take that out and instead we develop an implementation plan including the formation of an l tci implementation body. so if someone thinks about that i do have two or three questions and we can go forward >> i can move for us to add that amendment. >> okay. so why don't we hold that until i finish my question we can take the resolution then number one is obviously the program is a pioneer and this is a result of it which was caring for the frail and elderly is it
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intend to take care of and in order to subcommittee rule have to be part of the elderly. >> so it's focused on the elderly unlike the other two plans serving san francisco it would be designed to take care of the dial eligible population so people who are well, but the pace program is focused on the frail elderly. >> so in terms of it's really wonderful there's no question in fact, it was a bicentennial so here san francisco got highlighted which is wonderful. so talking about unlock in the community and cultural competency as part of what


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